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Foreign Travel With Medicare May Be Problematic

Do you travel a lot? If so, make sure you check whether or not Medicare is in force when you are abroad.

Read over your insurance policy and find out what it does and does not cover. If, at any point you do not understand what the document encompasses, talk to a qualified insurance agent and have them walk you through your policy before you start to travel with Medicare.

You may not know that Medicare Advantage Plans and Original Medicare do cover urgent or emergency medical services anywhere in the United States and its territories. So if you have a Medicare Advantage Plan, you are getting urgently or emergency medical care that:

  • Limits on how much the plan bills you by being out of network
  • Must cover follow-up care in relation to the emergency if delaying it puts your health in danger
  • Your plan cannot demand you see an in-network provider
  • You can appeal if your plan denies care costs
  • You do not need a referral
  • That if the condition was not an emergency but looked/felt like it was, Original Medicare/ Medicare Advantage must cover care

What happens if you are denied coverage of an urgent or emergency medical assistance because you went to an out-of-network provider without an OK or a referral? Appeal the denial and get the physician to provide the appropriate documentation that the medical services rendered were urgently needed or in response to an emergency. Your State Health Insurance Assistance Program can help you in putting together an appeal.

Medicare does not cover medical costs while you are travelling outside of the United States. However, the plans must cover care in certain circumstances, including: paying for care received on a cruise ship while that vessel is in U.S. territorial waters; paying for E.R. services in Canada while traveling a direct route between Alaska and another state and the nearest treating medical facility is in Canada; and in certain limited cases, Medicare may also pay for non-emergency inpatient care in a foreign hospital.

There are a few Medigap policies that offer coverage for travelers’ abroad and they include Medigap plans C through G, M and N and offer 80 percent of the cost of emergency care.

If you do not know what your plan does and does not cover, check your policy for specific rules, and if that is not clear, contact the insurance agent and ask them to discuss the relevant sections and what they mean when you are travelling outside the United States.